Field cancerization: Treatment - 19/08/20

Doi : 10.1016/j.jaad.2020.03.127

Christine M. Cornejo, MD ^a, Anokhi Jambusaria-Pahlajani, MD, MSCE ^b, Tyler J. Willenbrink, MD ^b, Chrysalyne D. Schmults, MD, MSCE ^a, Sarah T. Arron, MD, PhD ^c, Emily S. Ruiz, MD, MPH ^a,^⁎
^a Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
^b Division of Dermatology, Department of Internal Medicine, The University of Texas at Austin Dell Medical School, Austin, Texas
^c Department of Dermatology, University of California San Francisco, San Francisco, California

^∗Reprint requests: Emily Stamell Ruiz, MD, MPH, Department of Dermatology, Brigham and Women's Hospital, 1153 Centre St, Ste 4J, Boston, MA 02130.Department of DermatologyBrigham and Women's Hospital1153 Centre St, Ste 4JBostonMA02130

Abstract

The goal of field cancerization treatment is to reduce the risk of developing keratinocyte carcinoma. Selecting the appropriate therapy depends on the degree of field cancerization and the number of invasive cutaneous squamous cell carcinomas. Other considerations include treatment efficacy, cost, side effects, and patient preference. Field therapies are preferred because they address clinically visible disease and subclinical atypia. However, lesion-directed therapies are useful for lesions that are more difficult to treat or those where a histologic diagnosis is required. Patients with extensive field cancerization benefit from a combination of field-directed and lesion-directed treatments. The second article in this continuing medical education series provides a framework to guide evidence-based decision making for field cancerization treatment.

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Key words : actinic keratoses, cutaneous squamous cell carcinoma, field cancerization, keratinocyte carcinoma, solid organ transplant recipient

Abbreviations used : 5-FU, AK, BCC, c-PDT, CRR, CSCC, FC, FDA, IL, KC, RCT, SCCis, SOTR